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NPR Attacks Disability, Bolsters 'New Consensus' against Welfare

Disability activists blocked the street in San Francisco to protest cuts to programs that make independent living possible. The attack on benefits is nothing new to the disabled. Photo: Steve Rhodes.

Nearly two decades after Bill Clinton ended “welfare as we know it,” we’re seeing a new push to decimate what’s left of the safety net.

Conservatives and liberals alike who drank the Kool-Aid about the “success” of welfare reform are still waging war on welfare. Now NPR’s Planet Money has joined the chorus with Chana Joffe-Walt’s confused and rhetoric-heavy March 22 piece “Unfit for Work: The Startling Rise of Disability in America.” (Versions also aired on This American Life and All Things Considered.)

These stories have been largely right to focus on these issues—access is actually extremely difficult. The scandal is not that it’s too easy for the non-disabled to get benefits, as Joffe-Walt claims, but that it’s too hard for the disabled to be approved.

But there’s more to the story.

Joffe-Walt’s piece is part of a long lineage of shock journalism that targets poverty programs by misstating the facts and cynically focusing scrutiny on poor people who have almost nothing.

She’s one of many in the policy, journalistic, and academic worlds who are still trying to roll back the meager assistance available to poor people. The attack on disability benefits is part of a larger effort to reduce social service spending by the federal government—whether it be postal service, subsidized housing, or supported income.

Their consensus is that the state owes the working class—including those unable to get or hold a job—nothing.

Disability Benefits Basics: SSI and SSDI

Joffe-Walt’s piece focuses on two programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The process for determining medical eligibility is the same for both.

SSDI was legislated in the 1950s and provides assistance to disabled former workers who have paid a share of their income for the benefit, just as we do for regular Social Security. When you pay your Social Security tax each month you gain “credits.” After a certain number of credits you’re considered “insured”—i.e., eligible for SSDI. Without those credits you’re not “insured” and only able to access SSI if found unable to work.

SSI was enacted in 1972, part of the expanded poverty assistance produced by years of intense welfare rights struggles. Welfare rights activists argued that raising children was unwaged work and that the state should pay for it. During this time, even conservatives, including Richard Nixon, were seriously proposing guaranteed-income legislation for families.

SSI was a compromise that federalized the complicated already-existing state-level disability programs and created a national program for some of the “deserving poor”—in this case people with extremely limited resources and income who were deemed unable to work due to a disability, age, or blindness. Eligible applicants could receive a relatively small cash benefit.

A Brief History of Poverty Programs

I work with poor people in New York City, most of them homeless. Much of my day is spent trying to help folks get assistance—what in social services is sometimes referred to as “survival income.”

Let me start with some history. In the 1980s and 1990s, politicians, policy wonks, and academics developed what has been called the “new consensus” on welfare. They agreed that poverty could be solved largely by fixing poor people and ending their “dependency” on state aid, particularly Aid to Families with Dependent Children (AFDC). Many single (non-family) welfare recipients received aid through state-level programs that were also under assault under the guise of eliminating “dependency.”

“Welfare reform” targeted welfare recipients themselves—not poverty or the system that produces it. The new consensus united liberals and conservatives—in think tanks, policy groups, the halls of Congress, and universities—in a bipartisan attack on the safety net.

As an increasing number of disabled people accessed benefits in the 1990s, journalists and politicians launched a rhetorical war on those programs too, recalled disability scholar Billie Jo Rylance.

New consensus thinking was codified in the Family Support Act of 1988, which expanded work requirements for recipients and imposed big penalties for noncompliance. Work requirements are largely aimed at making sure that child-raising is not seen as valid labor—that only working for wages is seen as acceptable productive activity—and focusing anti-poverty strategies on individual behaviors instead of the economy.

Clinton’s 1996 Personal Responsibility and Work Opportunity Reconciliation Act went further—ending the meager cash entitlements of AFDC and replacing them with Temporary Assistance for Needy Families, the federally-funded cash assistance program for families in poverty.

TANF has a five-year time limit, mandates work requirements, and is provided through a block-grant structure that incentivizes states to close welfare cases. Most poor families do not receive TANF, even if they are objectively eligible—in 2012 about 4.1 million people accessed TANF assistance each month, more than 3 million of them children.

The new law also targeted disability programs like SSI by mandating reviews of childhood cases, tightening the threshold of medical approval, eliminating drug and alcohol abuse as disabling criteria, and restricting immigrants’ access to benefits rolls.

Disability is one of the last federal safety-net programs remaining, and politicians have long had their eyes on it, too. During the 1990s, according to congressional staffer Matt Weidinger, “the design of the SSI program was undermining long-held values of work and responsibility and in serious need of reform.”

SSI and SSDI are now front-and-center in the war on welfare.

Arduous Process

Today, the public assistance system in New York City is a churning machine. Poor people are denied left and right by arbitrary rules, improper procedure implementation, or complicated and exclusionary eligibility criteria. Recipients are routinely sanctioned from aid without any wrongdoing, and their time is treated as worthless.

The system is overwhelmingly focused on putting welfare recipients into mandatory “welfare-to-work” programs, which rarely provide useful skills or lead to decent jobs. Most recipients do not receive any cash benefits for the first 45 days of their application for aid. Upon approval, individual recipients receive a “basic allowance” cash grant of approximately $150 per month, while a family of two receives a cash grant of about $250. Recipients may also receive small allotments for utilities and rent. Those on the rolls attend work programs for about 35 hours per week, where they are ostensibly taught how to find a job and keep it.

Welfare workers face pressure from administrators to push recipients off the rolls. Recipients often cycle between precarious employment in retail or food service, and then back on the rolls. Other recipients maintain low-wage jobs while receiving limited benefit access. Rarely does anyone move out poverty.

The city now has more than 60,000 people living between the streets and the shelters. Many have no income. I often work with these individuals to make a claim for SSI or SSDI—an incredibly arduous process. It’s so complicated, and the threshold for medical eligibility is so high, that there is a pervasive understanding among social service staff and disability-income applicants alike that “you always get denied the first time.”

Applicants may then enter into a very lengthy appeals process. Denial rates for homeless adults for SSI and SSDI are over 80 percent on their first applications. For all initial claims combined, the denial rate is around 70 percent.

Eligibility is determined by analysts with the Disability Determination Services unit. In New York state, DDS workers are mostly located in the upstate region, hundreds of miles from the applicants about whose lives they make decisions. They have huge caseloads even as their staffing is reduced, and their cases receive constant review by superiors and “quality assurance” personnel within the Social Security Administration.

Because of the difficulty poor people have in accessing competent and thorough medical care, they often don’t have medical records that document their conditions. For the applicant who is claiming disability for mental health or cognitive difficulties, finding a psychiatrist or psychologist who can competently assess you is extremely hard. And your doctor’s support by no means assures that you will be found medically eligible.

If applicants cannot quickly provide up-to-date and useful medical documentation, DDS workers schedule them for a “consultative examination” with a doctor at a private company that subcontracts with the government. Those applying for disability due to psychiatric difficulties face an especially uphill battle, since these psychiatrists, who see many applicants each day, often don’t pick up on the less obvious forms of serious mental illness—for example, a person who has debilitating depression but appears to function without severe difficulty in a brief psychiatric interview, or a person with post-traumatic stress disorder whose difficulties may be extremely hard to see during a surface evaluation. Mental illness is a leading cause of disability that is often extremely difficult to assess—it’s one of many “invisible disabilities” that make people unable to maintain employment.

Further, any substance use may be considered “material” to a case, warranting automatic denial.

Equally difficult is finding a social worker or caseworker with the time to comprehensively explain a case to DDS to show how much difficulty an applicant faces day to day as a result of his or her disability. And because of the extremely strict approval criteria, even the best advocate will often experience baffling denials.

I have seen people with schizophrenia nearly denied SSI because a disability determination worker didn't see their illness as severe enough—even though they were street homeless and had a history of multiple psychiatric hospitalizations. Without strong documentation and advocacy by service providers in community agencies that serve poor people—which is extremely difficult to access, given the high demand—they would have been denied.

I have seen determination workers bluntly state that an applicant’s ability to “survive” is a criterion to be considered against their approval.

I have seen homeless applicants with severe bipolar disorder denied—they were unemployed and had been restricted from many programs such as shelters and community-based agencies due to difficulties with impulse control and violent outbursts—because their disability wasn’t seen as sufficiently debilitating.

In the unlikely event that an applicant is found medically eligible by the DDS worker, there is a good chance the case will get “sampled”: sent to another office for review to make sure it meets “quality assurance” standards. Then it is sent back to a local Social Security field office for income review and, potentially, issuance of aid.

Given all this, it is not surprising that most of those who apply for SSI or SSDI are denied upon initial application. Many don’t appeal their denials, especially if they are in a crisis situation due to their disability or poverty. Those who do appeal face an extreme burden of proof. Most SSDI applicants never obtain approval.

Further Hurdles

In New York City, for those who are applying for public assistance and experience a disability that makes them unable to work, the city’s Department of Social Services runs a program called WeCARE which contracts with private service providers to do disability assessments of applicants and determine if they should be exempted from work requirements. If a WeCARE provider agrees an applicant should be exempted, then the applicant may be placed on a path to receive public assistance while applying for SSI or SSDI.

Since welfare caseworkers are not medical practitioners or trained in disability assessment, they very often miss signs that an applicant is experiencing a disability that may preclude them from working. Accordingly, many disabled people applying for public assistance are not even aware of WeCARE. Often they are sent to a work program, experience a serious difficulty resulting from their disability, and are then sanctioned. This pushes many people experiencing medical or mental health difficulties, such as such as bipolar disorder, post-traumatic stress disorder, or major depression, off the rolls.

Given the many applicants who go through WeCARE each day, the program tends to function in a factory-like way, pushing clients through questions on computer screens, while overworked staffers rarely have time or energy to build rapport that might allow for a serious understanding of how mental illness impacts someone’s ability to work. Many who go through WeCARE have extreme difficulty making repeated appointment requirements, and their disabilities are often not appropriately assessed.

One in-depth report on WeCare by Community Voices Heard found that “WeCare vendors are not adequately assisting people to apply for federal disability benefits and are not helping individuals to appeal if they have been denied benefits.”

Taking Aim at Disability Benefits

Journalists and academics have launched a flurry of attacks on SSI and SSDI in recent years.

The only academic that Joffe-Walt cites, David Autor, co-wrote a major 2010 paper for the Brookings Institution and the liberal Center for American Progress arguing that “too many work-capable individuals involuntarily exit the labor force and apply for, and often receive, SSDI.” (In the All Things Considered version of the story, Joffe-Walt cites a second academic, Mark Duggan, the paper’s other author.)

A 2010 Boston Globe series called “The Other Welfare” made similar arguments about SSI. Journalist Patricia Wen claimed the program had “created, for many needy parents, a financial motive to seek prescriptions for powerful drugs for their children.”

Last year New York Times columnist Nicholas Kristof wrote about SSI: “This is painful for a liberal to admit, but conservatives have a point when they suggest that America’s safety net can sometimes entangle people in a soul-crushing dependency.”

Where are they all getting this line? Look no further than conservative policy advocates like Jason A. Turner, co-author of a recent paper on “Reforming Disability” for an organization of state human service secretaries.

The paper argues that SSI and SSDI “are engulfing ever more numbers into lives of permanent dependency, all with no evidence there is some national health epidemic.”

Turner has based his career on making the lives of poor people hellish. Clinton’s “end of welfare as we know it” was partially based on the “success” of Turner’s 1990s efforts in Wisconsin, where he decimated the welfare system and drastically reduced the rolls. Turner had been head of AFDC under the first President Bush during implementation of the Family Support Act, and after his experience in Wisconsin, Mayor Rudolph Giuliani brought him to New York, where he became welfare commissioner and oversaw the subtraction of hundreds of thousands—more than half of those enrolled—from welfare.

Now Turner and other influential neoliberal reformers have turned their attention to dismantling disability benefits, perceived to be the new AFDC.

It’s Turner’s line that journalists like Joffe-Walt are pushing, even if they don’t cite him.

Real-Life Consequences

The extremely high disability-benefit denial rate has serious real-life consequences. Without the benefit, many cannot afford a place to live, so they may end up homeless.

Poor people, including those with disabilities, are often pushed to engage in what are diplomatically called “survival behaviors”: committing low-level crimes, trading sex for shelter, or staying in abusive relationships.

Those pushed into survival situations often experience trauma—abuse by a partner, sexual assault, contraction of HIV or other infections as a result of sex work, or assault on the street or in a shelter. Sometimes interactions with service providers in the process of seeking assistance can also be traumatizing.

When people are approved, their situations may improve. They may have access to housing. They are more likely to access health care consistently. They are less likely to engage in high-risk survival behaviors.

The federal SSI benefit is about $710 per month. New York, like most states, adds a small subsidy to that, so a recipient who is homeless or lives in their own apartment receives a total of $797. Even though they are still poor—way below the federal poverty line—that $797 per month makes a tremendous difference in recipients’ lives.

However, approvals are the exception. As the city’s Independent Budget Office documented recently, the past decade has seen only a slight increase in the number of SSI recipients, and total SSI funds paid out has actually declined—even during an unprecedented economic crisis.

Any success in maintaining disability benefits will require a movement of poor people focused on keeping them. Such a movement has yet to emerge, but without it we may soon be looking at the “end of welfare as we know it”—again.

Jesse Bernstein is the pseudonym of a social worker in New York City. He has been active in social justice efforts for the past 15 years.

This article has been edited to correct an error: Welfare rolls declined by 59 percent from 1996 to 2003 (not 2002), a reduction of more than 7 million (not 8 million).